| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $45.65 | $45.65 | $45.65 | |
Aetna
| Professional | $37.95 | $45.65 | $45.65 | |
Kaiser Permanente
| Professional | $393.93 | $393.93 | $393.93 | |
Lucent Health
| Facility | $100.00 | $212.45 | $212.45 |